Promoting public health in nutrition: Nutri-Score and the tug of war between public health and the food industry

Dietary risk factors ranked in 2016 in the top three leading causes of morbidity and mortality in Western Europe.1 Such high burden of diseases urges the implementation of strong and efficient public health strategies in order to curb the impact of poor diets. The public health community has long promoted strategies impacting both individual dietary behavior and the food environment, in a consistent global framework. However, the latter strategies imply to act upon the food and beverage manufacturers, to provide consumers with better information on the nutritional quality of the foods they produce and to ensure a shift in the nutritional composition of the food offer towards healthier foods. Among the various public health nutrition strategies that are considered efficient in both modifying consumer behavior and enticing reformulations by the food industry, front-of-pack food labeling has been identified as a key policy component in a global program. The experience of France in the implementation of a front-of-pack label, the Nutri-Score, clearly illustrates the constant tug-of-war between public health experts and the food industry and provides a framework for an efficient strategy that could be replicated at the EU level. The Nutri-Score was introduced in the French debate in early 2014, as a five-category, colour-coded summary system, providing a single indicator of the nutritional quality of a food or beverage. It is based on an algorithm, the British Food Standards Agency (FSA) Nutrient Profiling System (NPS). It was adapted for the context of labeling in France by the Health Council of Public Health. The Nutri-Score was developed by an independent research team, and since 2014, multiple research studies have been conducted to validate it, both on its underlying classification system—the FSA-NPS—and its graphical format.2 These studies highlighted hat the FSA-NSP adequately classified foods according to their nutritional quality, and that the nutritional quality of the foods consumed––classified using the FSA-NSP––was associated in large cohorts with many years of follow-up with health outcomes. All studies compared the Nutri-Score to other types of labeling systems, allowing for a ranking of the various schemes in terms of effectiveness for the consumer. The selection of the Nutri-Score based on scientific evidence by the French government prompted the EU regional office of the WHO to congratulate France on its choice.3 But this choice is still under pressure, as the implementation of Nutri-score is voluntary (based on EU regulation). While some companies have pledged for it, others have already started counter projects, announcing they will implement another nutrition labeling system. A group of six multi-national corporations (Mars, Coca-Cola, Mondelez, Unilever, PepsiCo and Nestlé) are promoting their own system: the Evolved Nutrition Label (ENL), derived from the Multiple Traffic Lights (MTL), implemented in the UK since 2005. Their ‘evolved’ version, however, is defined on the basis of the contribution of a portion (defined by the food companies themselves), rather than by 100 g. Moreover, comparative studies conducted in France confirmed that the MTL system appeared strongly less operative than Nutri-Score to consumers. If implemented, this initiative would mislead and confuse consumers about the nutritional quality of the products.4 Many actors in nutrition and public health have been proactive in issuing a joint statement, signed by thousands of citizens and organizations, to stall their project.5 Health authorities, through ‘Santé Publique France’, the national public health agency, are now making extensive efforts to advocate for the Nutri-Score and gather more companies to pledge for it. The next steps may become more European, in the framework of the update of the regulation on the provision of food information to consumers (regulation n°1169/2011). The European Commission is scheduled to release a report on complementary front-of-pack nutrition labels currently in use in the EU in 2018. Such a report is expected to lay the grounds for a unified system across all EU countries, allowing consumers to understand and use at-a-glance nutrition information on the front of food packages. The EU commission has specified that its report would encompass a large number of front-of-pack label alternatives, including those backed by multi-national corporations, clearly not only for evidence-based public health reasons. And what occurred in France during the selection process for the best evidence-based labeling tool was clearly a way for the food industry to create as much confusion as possible in the mind of decision makers. Evidence is then challenged by never ending new proposals from the industry side, needing scientific evaluation. Science as a mean to postpone any mandatory choice. The confrontation observed in France between commercial interests and public health concerns would then widen its field to the EU. We strongly encourage the European public health and nutrition community to stay united and alerted on this coming challenge in the EU regulation process for food labeling. None. Conflicts of interest: None declared.